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JAWAHAR NAVODAYA VIDYALAYA,

--------------------------------DISTT.-------------------------------
FORMAT FOR PGTs (Other than PGT (IT) and Food Production and Beverage)/ TGTs (Other
than Music, Art, Lib. & PET) FOR EMPANELMENT OF TEACHERS PURELY ON CONTRACT
BASIS .

PART- I

1 Application for the post : …………………………………………………………………….


of (On Contract Basis)
Paste Latest
passport size
photograph of
2 Tel.No.(With STD : …………………………………………………………………….
Code)/Mobile No. ……………………………………………………………………. applicant

3 E-Mail Address : …………………………………………………………………….

4 Name : …………………………………………………………………….
(Capital Letter)

5 Father’s Name : …………………………………………………………………….


(Capital Letter)
6 Date of Birth
(DD/MM/YYYY)
As on 10-06-2017 : …………………………………………………………………….

7 Full Address for …………………………………………………………………….


Communication : …………………………………………………………………….
…………………………………………………………………….
…………………………………………………………………….

8 Home District : …………………………………………………………………….

9 (a) Category to which


belong
(Gen/SC/ST/OBC/PH) : …………………………………………………………………….

10 Sex : …………………………………………………………………….
2

11 Education Qualification :
S. Name of Exam Board/University Year of Subject Total aggregated Marks For Office use only
No. Passing Studied Maximum Obtained % (Calculation for
Marks Marks Eligible marks)
1 SECONDARY

2 SR.SECONDARY

3 GRADUATION
BA/B.Sc./B.Com)
(Others Please
specify)

4 POST
GRADUATION
(Mention
subject)

5 B.ED . (Theory &


Practical)

6 CTET (For TGTs


Only) conducted
by CBSE Paper II

7 Ph.D/M.Phil/NET
(For PGT only)

8 Other (If any)

(Kindly enclose proof in respect of conversion of grades into marks)


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(B) Co- Scholastic Achievement :

1 Representing National/SGFI in Sports and Games Attach copy of certificate


2 Representing State/University/Region in Sports and Games Attach copy of certificate
3 Representing Distt. in Sports and Games Attach copy of certificate
4 NCC ‘ C’ / ‘ B’ / ‘A’ Certificate Attach copy of certificate
5 NSS Attach copy of certificate
6 Scout & Guide President award/Government Award/ Tritiya Attach copy of certificate
Sopan
7 Certificate of performance awarded by Govt. Institution in Attach copy of certificate
Art/Music/Literature at “National level”
8 Certificate of performance awarded by Govt. institution in Attach copy of certificate
Art/Music/Literature at State Level
9 Teaching experience in day school/Residential Attach copy of certificate
A. Only for TGT (Mathematics)

Course Ist Year IInd Year IIIrd Year Total marks Maximum Remarks
of Subject %age of Subject %age of Subject %age of obtained (all Marks
Study Offered Marks Offered Marks Offered Marks year allowed
obtained obtained obtained together) (All year
together)
B.Sc 1 Maths Maths Maths Attach
copy of
Physics Physics Physics mark
sheet of
Chemistry Chemistry Chemistry B.Sc I,II,III

B. Only for TGT (Science)

Course Ist Year IInd Year IIIrd Year Total marks Maximum Remarks
of Subject %age of Subject %age of Subject %age of obtained (all Marks
Study Offered Marks Offered Marks Offered Marks year allowed
obtained obtained obtained together) (All year
together)
B.Sc 1 Chemistry Chemistry Chemistry Attach
copy of
2 Biology Biology Biology mark
sheet of
3 Zoology Zoology Zoology B.Sc I,II,III

C. Only for TGT (Social Studies)

Course Ist Year IInd Year IIIrd Year Total marks Maximum Remarks
of Subject %age of Subject %age of Subject %age of obtained (all Marks
Study Offered Marks Offered Marks Offered Marks year allowed
obtained obtained obtained together) (All year
together)
B.A 1 History History History Attach
copy of
2 Geography Geography Geography mark
sheet of
3 Economics Economics Economics B.A I,II,III

4 Pol. Science Pol. Science Pol. Science


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D. Only for TGT (English)

Course Ist Year IInd Year IIIrd Year Total marks Maximum Remarks
of Subject %age of Subject %age of Subject %age of obtained (all Marks
Study Offered Marks Offered Marks Offered Marks year allowed
obtained obtained obtained together) (All year
together)
B.A 1 English English English Attach
Elective Elective Elective copy of
mark
sheet of
B.A I,II,III

E. Only for TGT (Hindi)

Course Ist Year IInd Year IIIrd Year Total marks Maximum Remarks
of Subject %age of Subject %age of Subject %age of obtained (all Marks
Study Offered Marks Offered Marks Offered Marks year allowed
obtained obtained obtained together) (All year
together)
B.A 1 Hindi Hindi Hindi Attach
Elective Elective Elective copy of
mark
sheet of
B.A I,II,III
F. Only for TGT (Third Language)

Course Ist Year IInd Year IIIrd Year Total marks Maximum Remarks
of Subject %age of Subject %age of Subject %age of obtained (all Marks
Study Offered Marks Offered Marks Offered Marks year allowed
obtained obtained obtained together) (All year
together)
B.A 1 Hindi Hindi Hindi Attach
Elective Elective Elective copy of
mark
sheet of
B.A I,II,III

G. Experience in Govt. residential Schools

S.No. Name of the Name of the Post From To Total Period (Year Scale/Pay
Institution Held and Months) Drawn
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(FOR OFFICE USE ONLY (TOTAL MARKS)

I solemnly undertake that in the event of my appointment on contractual basis in the Samiti, my
services are liable to be terminated without notice if any of the foregoing information furnished by
me in my application form is found to be wrong or suppressed. I further understand that this
appointment is purely on contract and does not confer the right for regularization.

DATE:………………………

SIGNATURE OF CANDIDATE

PART-II CERTIFICATE (For Office Use)

Certified that the information filled up by the applicant in Part-I above have been scrutinized
personally with originals and found it to be in order. Candidate is eligible for the post

SIGNATURE OF THE OS/VERIFYING COMMITTEE

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